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Source: Disturbances Of The Heart
If a chronic endocarditis has followed an acute condition, some
slight permanent papillomas or warty growths may he left from the
healed granulating or ulcerated surfaces. Sometimes these little
elevations on the valves become inflamed and then adhere together,
or adhere to the wall of the heart, and thus incapacitate a valve.
Sometimes these excrescences undergo partial fatty degeneration, or
may take on calcareous changes and thus stiffen a valve.
If the chronic inflammation is not superimposed on an acute
endocarditis there may be no cell infiltration and therefore no
softening, but there is a tendency to develop a fibrillated
structure, and a fibroid thickening of the endocardium occurs,
especially around the valves. This induration causes contraction and
narrowing of the orifices with shortening and thickening of the
chordae tendineae, and the valves imperfectly open, or no longer
close. Fatty degeneration may occur in the papillary growths with
necrotic changes, and this may lead to the formation of atheromatous
ulcers which may later become covered with lime deposits, and then a
hard calcareous ring may form. Fibrin readily deposits on this
calcareous substance and may form a permanent capping, or may slowly
disintegrate and allow fragments to fly off into the blood stream
and cause more or less serious embolic obstruction. If this chronic
endocarditis develops with a general arteriosclerosis, the wine
inflammation soon occurs in the aorta, and, following the
endarteritis in the aorta, atheromatous deposits may also occur
there. Chronic endocarditis of the walls of the heart, not in
immediate continuity with endocarditis of the valves, is perhaps not
liable to occur, except with myocarditis.
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